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Tuberculous meningitis usually results from hematogenous seeding of the central nervous system from a primary pulmonary source of infection. Initially, the meningitic process can mimic a flu-like syndrome, followed rapidly by the development of profound neurologic deficits. Computed tomography scanning or magnetic resonance imaging of the head often demonstrates a characteristic pattern of basal cistern involvement with Mycobacterium tuberculosis. The incidence of tuberculous meningitis in the more developed countries has increased during the past 5 years because of the growing number of cases in patients with acquired immunodeficiency syndrome, the spread among the homeless, and the expanding immigrant population. The significant morbidity and mortality rates associated with tuberculous meningitis--generally considered to be a disease of the past--emphasize the need for greater clinical awareness, early diagnosis, and prompt treatment.